Year: 2026
Type: conference-abstract
Abstract: Background/Introduction Endovascular thrombectomy (EVT) is a key component of modern acute ischaemic stroke care. At national level, EVT rate may reflect the organisation of stroke pathways, imaging triage, transfer networks, and post-acute care, but this has not been tested with repeated observations over time. Objective/Purpose To assess whether national EVT rate is associated with population-level stroke burden across countries, and to distinguish between stable between-country differences and within-country temporal changes. Methods/Case Description We performed a repeated cross-sectional ecological analysis of 39 countries across three survey waves (2016, 2019, 2020). National EVT rates from European Stroke Organisation surveys were linked to year-matched Global Burden of Disease estimates. The primary endpoint was ischaemic stroke mortality-to-incidence ratio (MIR). Associations were analysed using a Mundlak within-between decomposition adjusted for socio-demographic index and age structure, with country-clustered standard errors and wild cluster bootstrap inference. Results/Findings Higher between-country EVT rate was associated with lower ischaemic stroke MIR (β_between −0.0125, p=0.021; bootstrap p=0.007; 117 country-year observations). No consistent within-country association was observed (β_within −0.0017, p=0.401). Between-country associations were also found for ischaemic stroke YLLs (p=0.049), all-stroke YLLs (p=0.016), all-stroke DALYs (p=0.022), and all-stroke MIR (p=0.007). The between-country EVT signal remained directionally stable in sensitivity analyses including Gini index, universal health coverage, total health expenditure, IVT rate, and stroke-unit density. Discussion/Conclusions/Learning Points National EVT rate appears to function primarily as a cross-national indicator of organised stroke-system capacity rather than as a short-term predictor of modelled burden reduction. For thrombectomy-focused health-system assessment, EVT rate may offer a pragmatic benchmarking metric when harmonised international quality indicators are unavailable. Short-term increases in EVT rate alone should not be interpreted as immediate evidence of improved population outcomes.
Institution: Essen University Hospital
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7204994978